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Fig. 4A —Agility Total Ankle System (DePuy) has been available for use since 1984, making it longest-used total ankle replacement system in United States. Agility ankle is porous-coated, two-piece (fixed-bearing) implant with partially conforming articulation. Modular, concave polyethylene insert (asterisk) locks into tibial component (thin arrow). Talar component (thick arrow) articulates with tibial component with approximately 20° of external rotation. Syndesmotic fusion (double arrowheads, B) increases surface area of tibial component prosthesis–bone interface in attempt to resist subsidence while allowing fibula to share portion of load. Failure of syndesmotic fusion is associated with increased rate of failure [8]. Photograph of Agility device, oblique frontal view.